Heavy, Puffy Upper Eyelids. Age 44 Woman; Options? (photo)

I'm a 44 year old women who was born with a heavier, puffy, fuller upper eyelid. I have always been self concious about the puffy part of my eyelids so much I wear sunglasses everywear I go to hide my eyes. If theres ever a day where I eat to much salt they get even puffier, and to top it off now that I'm older the skin is starting to droop. What can I do to correct my issue without looking like a differnt person...and will botox or fillers help? I have attach two photos taken 8 years apart.

Doctor Answers 13

Options for heavy puffy upper eyelids

The primary goal of a blepharoplasty procedure is to remove excess skin touching the upper eyelids without changing the shape of the eyes.  There are 2 compartments of fat that can be removed to give a deeper set and crease on the upper eyelids.  Any further deepening of the crease can be performed if needed by taking a small strip of orbicularis oculi muscle.  This is usually performed under brief general anesthesia.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Upper Eyelid Surgery with Botox Brow Lift

Based on your photos, I would suggest you need an upper eyelid blepharoplasty. This eyelift procedure is done to reduce excess skin and fatty tissue which hang over the eyes. It's important to choose a highly experienced specialist to insure the best results. You may consider a brow lift procedure however from the appearance of your photo, I'd be concerned about raising your hairline with such a a procedure. In my practice in New York, I often combine upper eyelid blepharooplasty with a non-invasive brow lift such as a Botox brow lift. This procedure allows the muscles which cause the brows to come down to be relaxed the brows come up.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Surgical options for your eyelids

Based on your photos you would appear to be an excellent candidate for upper lid blepharoplsty. There is no "non surgical "substitue for removal of the excess skin that you have. This is a common procedure with a very high satisfaction rate. Be carefull not to remove too much of the fullness of your lids as that is a very youthfull feature that you are lucky to have.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 105 reviews

Surgical options while maintaining your ethnicity

After viewing your photos, I have determined that you are certainly a canidate for an upper blepharoplasty which can be performed under a local anesthetic with an average downtime of 5 to 7 days.  The key for you is going to be maintaining your ethnicity while achieving your surgical goals. It will be imperative for you to seek out a board certified plastic surgeon with an emphasis on facial plastic surgery in order to ensure you achieve a result that suits your aesthetic.  Less is more in this instance. 

Timothy Treece, MD, FACS
Columbus Plastic Surgeon
4.6 out of 5 stars 23 reviews

Heavy, Puffy Upper Eyelids

You seem to be a good candidate for upper lid blepharoplasty. You seem to have physical chacteristics similar to an Asian upper eyelid. Consult with 2 - 3 board certified plastic surgeons who has the experience and expertise with this type of patient to understand your treatment options.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.4 out of 5 stars 41 reviews


The "full eyelid" features that you describe are not uncommon in patients of Latino heritage, and sometimes seem more "Asian" than Caucasian.

The issue at hand is that unless we examine you in person, its tough for us to see if you have a lid crease or not.

In your case, I would say "less is more". That is, removing a modest amount of skin, without fat or muscle excision will give you a natural look without causing hollowing in the future. My colleagues are correct that "fullness" is the sign of youth, and overdoing this surgery will make you look older before your time.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 38 reviews

Blepharoplasty Can Help, But Clearly Communicate Your Goals

When I look at your pictures, you have some characteristics of an Asian upper eyelid.  Asians typically have fullness in their upper lid and lack the crease in the area.  Without a crease, it gives the illusion of a fuller upper lid.  In your case, you need to have a discussion with your surgeon to identify your goals.  Do you want a crease?  How much fullness would you want to have removed.  You have to remember that full lids are a sign of youth, and you do not want to hallow out your upper lids.  In the limited information that we have, I would recommend having an upper blepharoplasty, conservative fat excision, and possible creation of an eyelid crease.


I hope this helps.  

Jonathan Kulbersh, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 66 reviews

Puffy upper eyelids

Based on the information and photos  ( photos need to be close up) that you have provided, it appears that you are a candidate for an Upper Lid Blepharoplasty.   This can safely be done as an outpatient,  or an office procedure.  Looks like you were just born with a little too much upper eyelid skin. Consult with a Board Certified Plastic Surgeon, certified with the American Society of Plastis Surgery (ASPS) for his recommendation.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 60 reviews

Puffy upper eyelids

Full upper eyelids are generally a sign of youth and a good thing to have, however, in your case, they are excessive and making you look Asian (assuming you are not).  You are a candidate for conservative upper blepharoplasty, which can be done under local anesthesia.  See an oculoplastic specialist.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 reviews

Help for Heavy Puffy Upper Eyelids

The bad news is that Botox or fillers aren't going to make much of a difference for you. The good news is that upper eyelid surgery (to remove the excess skin and fat) would likely give you the results you desire. Typically this surgery is done for changes that occur with aging. In your case, you simply appear to have congenital heaviness to your upper eyelids so that when you did start to get the very early signs of  upper lid aging, the heaviness was exaggerated. In some people, the situation is made worse when the eyebrows start to fall (normal aging). Your eyebrows however, seem to be sitting at a good height and my guess is that upper eyelid surgery alone would solve your problem.The surgery is done through a small incision that hides in the normal upper eyelid crease.It can be done with either a local or general anesthetic and most people look good in a little over 1 week.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.